System and method for creating a decision support material indicating damage to an anatomical joint

ABSTRACT

A system for creating decision support material indicating damage to an anatomical joint of a patient. The system is configured to: i) receive a series of radiology images of at least a part of the anatomical joint; ii) obtain a three-dimensional image representation of the at least part of the anatomical joint; iii) identify tissue parts of the anatomical joint using image analysis; iv) determine damage to the anatomical joint by analyzing said image representation; v) mark damage to the anatomical joint in the obtained three-dimensional image representation; and vi) generate decision support material. The analysis comprises: detecting an irregular shape of a contour of a tissue part; and/or detecting that the intensity in an area within or adjacent to bone and/or cartilage parts differs from a predetermined value; and/or comparing at least one identified tissue part with a template representing a predefined damage pattern for an anatomical joint.

CROSS-REFERENCE TO RELATED APPLICATION

This application is a continuation of U.S. application Ser. No.15/382,523, filed Dec. 16, 2016, entitled “SYSTEM AND METHOD FORCREATING A DECISION SUPPORT MATERIAL INDICATING DAMAGE TO AN ANATOMICALJOINT,” which claims benefit of EP Application No. 15201361.1, filedDec. 18, 2015, the content of which is incorporated by reference hereinin its entirety.

TECHNICAL FIELD

The present disclosure relates generally to systems and methods forcreating a decision support material indicating damage to at least apart of an anatomical joint of a patient.

BACKGROUND

In order to determine damage to an anatomical joint, it is common inmedical practice today to use imaging techniques to depict theanatomical joint of interest and further to have a medical expertanalyze the captured image data to determine whether there is damage.The medical expert then makes annotations about the conclusions drawnfrom the analysis of image data. The annotations are made available to asurgeon or orthopedic staff member who uses the annotations and thecaptured image data as a decision support for diagnosis and decision ofsuitable treatment of the patient.

However, this process is not very efficient as a manner of providingdecision support, as only a fraction of the information that the medicalexpert in this way gathers when analyzing the image data, based on theknowledge of the medical expert, can be communicated in the presentannotation format. Therefore, the decision support material received bythe surgeon or orthopedic staff member is often inadequate.

Pierre Dodin et al: “A fully automated system for quantification of kneebone marrow lesions using MRI and the osteoarthritis initiative cohort”,Journal of Biomedical Graphics and Computing, 2013, Vol. 3, No. 1, 20Nov. 2012 describes an automated BML quantification method.

WO 2015/117663 describes a method of manufacturing a surgical kit forcartilage repair in an articulating surface of a joint in which a threedimensional image representation of a surface of the joint is generated.

PROBLEMS WITH THE PRIOR ART

The method described in “A fully automated system for quantification ofknee bone marrow lesions using MRI and the osteoarthritis initiativecohort” only detects bone marrow lesions, i.e. lesions in the cancellousbone—not even damage to the subchondral bone plate will be detected.This does not provide conclusive information regarding anything exceptthe cancellous bone—it is not possible to draw definite conclusionsregarding the cartilage status or the functioning of the joint. If theree.g. is a problem with just the cartilage, this will not be detectedusing the method described in the article. Further, it is not possibleto judge the extent of the damage to a joint using just BML detection.

There is a need to address these problems of conventional methods andsystems.

SUMMARY

The above described problems are addressed by the claimed system forcreating a decision support material indicating damage to at least apart of an anatomical joint of a patient, wherein the created decisionsupport material comprises one or more damage images. The systemcomprises a storage media and a processor which is configured to: i)receive a series of radiology images of the at least part of theanatomical joint from the storage media; ii) obtain a three-dimensionalimage representation of the at least part of the anatomical joint whichis based on said series of radiology images by generating saidthree-dimensional image representation in an image segmentation processbased on said radiology images, or receiving said three-dimensionalimage representation from the storage media; iii) identify tissue partsof the anatomical joint, including at least cartilage, tendons and/orligaments, in at least one of the series of radiology images and/or thethree-dimensional image representation using image analysis; iv)determine damage to the anatomical joint by analyzing at least one ofthe series of radiology images and/or the three-dimensional imagerepresentation of the at least part of the anatomical joint; v) markdamage to the anatomical joint in the obtained three-dimensional imagerepresentation of the at least part of the anatomical joint; and vi)generate a decision support material, where damage to the anatomicaljoint is marked in at least one of the one or more damage images of thedecision support material, and at least one of the damage images isgenerated based on the obtained three-dimensional image representationof the at least part of the anatomical joint. The analysis of said atleast one of the series of radiology images and/or the three-dimensionalimage representation of the at least part of the anatomical joint usesthe identified tissue parts and comprises a selection of: detecting anirregular shape of a contour of at least one tissue part of theanatomical joint; and/or detecting that the intensity in an area withinor adjacent to bone and/or cartilage parts of the anatomical joint ishigher or lower than a predetermined value; and/or comparing at leastone identified tissue part with a template representing a predefineddamage pattern for an anatomical joint. The claimed system creates adecision support material which clearly visualizes the extent of damageto the joint or a part of the joint, such as damage to the cartilage andunderlying bone.

The series of radiology images may be captured during a process ofradiology scanning through different layers of the anatomical joint orpart of it, which captures all the radiology image data necessary togenerate a three-dimensional image representation of the anatomicaljoint or part of it in an image segmentation process based on saidradiology images.

The processor may be configured to identify bone parts and/or cartilageparts of the joint in the radiology image by detecting high contrastareas such as edges or contours in the radiology image, and identifyingstructures, such as bone and/or cartilage, in the radiology imagethrough comparing the detected edges or contours with predefinedtemplates.

The processor may, also or alternatively, be configured to associate theradiology images and the three-dimensional image representation, so thata marking made in one of the images appears in the same position in theother image. This simplifies the marking process.

The processor may, also or alternatively, be configured to select asuitable treatment from a predefined set of treatments based on datafrom the radiology images and/or the three-dimensional imagerepresentation of the at least part of the anatomical joint. Thetreatment may e.g. be the selection of a suitable implant from apredefined set of implants with varying dimensions, or the proposal of atransfer guide tool for graft transplantation, possibly includingsuitable size and/or suitable harvesting and/or implantation positionsfor osteochondral autograft plugs. In this case, the processor mayfurther be configured to visualize the selected implant and/or thesuitable transfer guide tool and/or the suitable harvesting and/orimplantation positions for at least one osteochondral autograft plug inat least one of the one or more damage images.

The above described problems are also addressed by the claimed methodfor creating a decision support material indicating damage to at least apart of an anatomical joint of a patient, wherein the created decisionsupport material comprises one or more damage images. The methodcomprises the steps of: i) receiving a series of radiology images of theat least part of the anatomical joint; ii) obtaining a three-dimensionalimage representation of the at least part of the anatomical joint whichis based on said series of radiology images by generating saidthree-dimensional image representation in an image segmentation processbased on said radiology images, or receiving said three-dimensionalimage representation from the storage media; iii) identifying tissueparts of the anatomical joint, including at least cartilage, tendonsand/or ligaments, in at least one of the series of radiology imagesusing image analysis; iv) determining damage to the anatomical joint byanalyzing said at least one of the series of radiology images and/or thethree-dimensional image representation of the at least part of theanatomical joint using the identified tissue parts and a selection of:detecting an irregular shape of a contour of at least one tissue part ofthe anatomical joint; and/or detecting that the intensity in an areawithin or adjacent to bone and/or cartilage parts of the anatomicaljoint is higher or lower than a predetermined value; and/or comparing atleast one identified tissue part with a template representing apredefined damage pattern for an anatomical joint; v) marking damage tothe anatomical joint in the obtained three-dimensional imagerepresentation of the at least part of the anatomical joint; and v)generating a decision support material, where the determined damage tothe anatomical joint is marked in at least one of the one or more damageimages of the decision support material, and at least one of the damageimages is generated based on the obtained three-dimensional imagerepresentation of the at least part of the anatomical joint. The claimedmethod creates a decision support material which clearly visualizes theextent of damage to the joint or a part of the joint.

The image analysis may identify bone parts and/or cartilage parts of thejoint in the radiology image by the steps of detecting high contrastareas such as edges or contours in the radiology image, and identifyingstructures, such as bone and/or cartilage, in the radiology imagethrough comparing the detected edges or contours with predefinedtemplates.

The radiology images and the three-dimensional image representation maybe associated so that a marking made in one of the images appears in thesame position in the other image. This simplifies the marking process.

The method may further comprise selecting a suitable treatment from apredefined set of treatments based on data from the radiology imagesand/or the three-dimensional image representation of the at least partof the anatomical joint. The treatment may e.g. be the selection of asuitable implant from a predefined set of implants with varyingdimensions, or the proposal of a transfer guide tool for osteochondralautograft transplantation, possibly including suitable size and/orsuitable harvesting and/or implantation positions for osteochondralautograft plugs. In this case, the method may further comprisevisualizing the selected implant and/or the suitable transfer guide tooland/or the suitable harvesting and/or implantation positions for atleast one osteochondral autograft plug in at least one of the one ormore damage images.

In the above described systems and methods, the image segmentationprocess may e.g. depend on a segmentation process control parameter set.If the image analysis identifies both bone parts and cartilage parts ofthe anatomical joint, damage may be determined to both the bone partsand the cartilage parts. The anatomical joint may be a knee, but mayalso be another joint such as an ankle, a hip, a toe, an elbow, ashoulder, a finger or a wrist. The decision support material may e.g. beadapted to be used by medical staff. It may include a recommendation fora suitable treatment for repair of the determined damage.

The above described problems are also addressed by a decision supportmaterial indicating damage to at least a part of an anatomical joint ofa patient, wherein the decision support material comprises one or moredamage images generated by the method steps of any one of the abovedescribed methods.

The above described problems are also addressed by a non-transitorymachine-readable medium on which is stored machine-readable code which,when executed by a processor, controls the processor to perform any oneof the above described methods.

The scope of the invention is defined by the claims, which areincorporated into this section by reference. A more completeunderstanding of embodiments of the invention will be afforded to thoseskilled in the art, as well as a realization of additional advantagesthereof, by a consideration of the following detailed description of oneor more embodiments. Reference will be made to the appended sheets ofdrawings that will first be described briefly.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1 shows a schematic view of a system for creating a damage image ofat least a part of an anatomical joint, in accordance with one or moreembodiments described herein.

FIG. 2 is a flow diagram for a method for creating a damage image of atleast a part of an anatomical joint, in accordance with one or moreembodiments described herein.

FIG. 3 shows an example of a decision support material in the form of adamage image wherein damage to an anatomical joint is marked usinggraphics, in accordance with one or more embodiments described herein.

FIG. 4 is a flow diagram for a method for creating a damage image of atleast a part of an anatomical joint, in accordance with one or moreembodiments described herein.

FIG. 5 shows an example of a decision support material in the form of adamage report comprising a number of damage images wherein damage to ananatomical joint is marked and/or a type and placement of a suitableimplant is indicated, in accordance with one or more embodimentsdescribed herein.

FIG. 6 shows an example of a decision support material in the form of adamage image wherein damage to an anatomical joint is marked using anannotation, in accordance with one or more embodiments described herein.

FIG. 7 is a flow diagram exemplifying the steps from obtaining medicalimage data to designing and producing an implant and/or guide tool forrepair of a determined damage to an anatomical joint, including thesteps of damage marking and generation of a damage marking image orreport in accordance with one or more embodiments described herein.

FIG. 8 shows an example of a damage image, in accordance with one ormore embodiments described herein.

Embodiments of the present disclosure and their advantages are bestunderstood by referring to the detailed description that follows. Itshould be appreciated that like reference numerals are used to identifylike elements illustrated in one or more of the figures.

DETAILED DESCRIPTION Introduction

The present disclosure relates generally to systems and methods forcreating a decision support material indicating damage to at least apart of an anatomical joint of a patient.

More specifically, system and method embodiments presented hereinprovide an improved decision support material by creating one or moredamage images of at least a part of an anatomical joint of a patient,wherein damage to the joint or a part of the joint is marked in at leastone of the one or more damage images. In other words, there is providedone or more visualizations of a patient's joint together withindications/markings/visualization of its anatomical deviations, whichforms a decision support for a surgeon or orthopedic staff member indeciding on an optimal treatment method, a decision support for aninsurance agent making an assessment regarding a client or potentialclient, a decision support for a patient who wants to be informed aboutthe condition of a damaged joint, or a decision support for any otherperson that has for example a commercial or academic interest inlearning about damage to a depicted anatomical joint. This providesgreat advantages compared to conventional systems and methods, as muchmore information obtained from the medical image data is communicated,for example to the person making the decision on treatment of thepatient. Thereby, embodiments of the invention solve the identifiedproblems that the decision support material received by the surgeon ororthopedic staff member is many times inadequate as only a fraction ofthe information that a medical expert gathers when analyzing the imagedata, based on the knowledge of the medical expert, is communicated. Inother words, using embodiments presented herein, an improved decisionsupport material is obtained, which leads to more informed decisionsbeing made on the optimal treatment of the patient whose anatomicaljoint is depicted in the decision support material.

In some embodiments, the anatomical joint is a knee, but the methods andsystems presented herein may be used for deriving damage images of anysuitable anatomical joint, e.g. an ankle, a hip, a toe, an elbow, ashoulder, a finger or a wrist. Damage need not be determined to a wholeanatomical joint—often only a part of the joint is of interest, such asthe femoral part of the knee joint.

In a non-limiting example, the anatomical joint is a knee and thedamage/anatomical deviations that are determined andindicated/marked/visualized in the damage image are related to thefemoral part of the knee joint, such as chondral and/or osteochondrallesions. In another non-limiting example, the anatomical joint is anankle and the damage/anatomical deviations that are determined andindicated/marked/visualized in the damage image are related to thetalus.

The damage image may comprise image data from a 2D representation of agenerated 3D model of the anatomical joint, and/or comprise 2D imagedata retrieved directly from a digital imaging and communications inmedicine (DICOM) file or any other suitable image file format. The 3Dmodel may for example be generated based on a series of radiology imagescaptured during a process of scanning radiology images through differentlayers of the anatomical joint or part of it, which captures all theradiology image data necessary to generate a 3D image representation ofthe anatomical joint or part of it in an image segmentation processbased on said radiology images. A 3D model is advantageous forvisualizing damage to bone, cartilage and other tissues. The DICOMformat, or a comparable image file format, is advantageous forvisualizing different parts of the anatomical joint.

For example, a 3D model may be used for visualizing bone and tissuessuch as cartilage, tendons and/or ligaments, and damages in relation tofemoral knee bone and cartilage, or bone and cartilage of any otherrelevant anatomical joint that is being investigated. In anotherexample, the DICOM format, or a comparable image file format, may beused for visualizing different parts of a knee, such as the femoralcondyle and the trochlea area, or different parts of any other relevantanatomical joint that is being investigated, such as the talus of theankle.

One or more damage images may be included in a damage assessment reportthat forms a decision support material to, for instance, facilitate fora surgeon or orthopedic staff member to make a correct diagnosis anddecide on an optimal treatment of the patient. The one or more damageimages, or the damage assessment report including the one or more damageimages, do not include any diagnosis. Instead, they form a decisionsupport for making a correct diagnosis and/or decide on an optimaltreatment of the patient. The decision support material comprising oneor more damage images, or a damage assessment report including one ormore damage images, may for instance be used as a pre-arthroscopic tool,a digital version of standard arthroscopy to be used prior to anarthroscopy to give an arthroscopist a visual understanding of whathe/she can expect to see. The decision support material may also be usedas an alternative to arthroscopy, since enough information can often begathered in this way without submitting the patient to an arthroscopy.The decision support material may in this case be used for planning thepreferred treatment, such as an arthroplasty, a biological treatmentsuch as a mosaicplasty of a microfracturing, or if a metal implant isneeded.

In other examples, other types of users may receive and use the decisionsupport material for different purposes. The decision support material,in the form of one or more damage images, or in the form of a damageassessment report including one or more damage images, may in differentsituations be of interest to medical staff, an insurance agent assessinga client or a potential client, a patient who wants to be informed aboutthe condition of a damaged joint, or any other person who has forexample a commercial or academic interest in learning about damage to adepicted anatomical joint. In different embodiments, the damage image ordamage assessment report may be represented in printed form or indigital form. In digital form, the damage image, or the one or moredamage images included in the damage assessment report, may be in staticformat or in a format allowing a user who is viewing a damage image on adisplay of a processing device to manipulate the image, by providing acontrol signal using an inputter connected to the processing device. Theinputter may for example comprise a keyboard, a computer mouse, buttons,touch functionality, a joystick, or any other suitable input device.

In some embodiments, the decision support material may further include arecommendation and/or a position indication of a suitable implant forthe determined bone and/or cartilage damage. In this context, a suitableimplant means an implant having a type and dimensions that match adetermined damage, thereby making it suitable for repairing thedetermined damage. Such a suitable implant may further be visualized inthe damage image or damage report.

The decision support material may in some embodiments instead include arecommendation indicating a suitable transfer guide tool and/or suitableharvesting and/or implantation positions for at least one osteochondralautograft plug. The suitable transfer guide tool and/or the suitableharvesting and implantation positions may further be visualized in thedamage image or damage report.

In some embodiments, the decision support material further indicatesanatomical deviations which do not in themselves constitute damage tothe joint. Such anatomical deviations may e.g. affect the choice oftreatment for the determined damage. As a non-limiting example, severeosteophyte problems may indicate other problems, where an implant maynot improve the situation.

The processor may in some embodiments comprise several differentprocessors which together perform the claimed functions. In the sameway, the storage media may in some embodiments comprise severaldifferent storage media which together perform the claimed functions.

System and method embodiments of the disclosed solution are presented inmore detail in connection with the figures.

System Architecture

FIG. 1 shows a schematic view of a system 100 for creating a decisionsupport material indicating damage to at least a part of an anatomicaljoint of a patient, the decision support material comprising one or moredamage images. According to embodiments, the system comprises a storagemedia 110, configured to receive and store image data and parameters. Insome embodiments, the system 100 is communicatively coupled, asindicated by the dashed arrow in FIG. 1, to an imaging system 130. Theimaging system 130 may be configured to capture or generate radiologyimages, such as for example X-ray images, ultrasound images, computedtomography (CT) images, nuclear medicine including positron emissiontomography (PET) images, and magnetic resonance imaging (MRI) images.The storage media 110 may be configured to receive and store radiologyimages and/or radiology image data from the imaging system 130.

The system 100 further comprises a processor 120 configured to, based onimage data, determine damage in an anatomical joint, and create a damageimage of the anatomical joint or a part of it where the determineddamage to the joint is marked, or in other ways visualized, such that anobserver of the damage image is made aware of the damage. The processor120 may for example be a general data processor, or other circuit orintegrated circuit capable of executing instructions to perform variousprocessing operations.

In one or more embodiments, the processor is configured to: receive aseries of radiology images of at least a part of the anatomical jointfrom the storage media; obtain a three-dimensional image representationof the at least part of the anatomical joint which is based on saidseries of radiology images by generating said three-dimensional imagerepresentation in an image segmentation process based on said radiologyimages, and/or receiving said generated three-dimensional imagerepresentation from the storage media; identify tissue parts of theanatomical joint, including at least cartilage, tendons and/orligaments, in at least one of the series of radiology images, and/or thethree-dimensional image representation, using image analysis; anddetermine damage to the anatomical joint by analyzing said radiologyimage and/or the three-dimensional image representation of theanatomical joint or part of it. The processor 120 may be configured touse the identified tissue parts and perform a selection of the followingimage analysis and processing operations:

-   -   detecting an irregular shape of a contour of at least one tissue        part of the anatomical joint;    -   detecting that the intensity in an area within or adjacent to        the bone and/or cartilage parts of the anatomical joint is        higher or lower than a predetermined value; and/or    -   comparing at least one identified tissue part with a template        representing a predefined damage pattern for an anatomical        joint.

The processor 120 is further configured to mark damage to the anatomicaljoint in the obtained three-dimensional image representation of theanatomical joint or part of it; and generate a decision support materialwhere the determined damage to the anatomical joint is marked in atleast one of the one or more damage images of the decision supportmaterial, and at least one of the damage images is generated based onthe obtained three-dimensional image representation of the anatomicaljoint or part of it.

It may in some embodiments be advantageous to identify and analyze boneand cartilage of the depicted joint in the input radiology image/medicalimage data, as the combination of the two may provide additionalinformation, but all embodiments described herein can also be performedwhen other tissues of the depicted joint are identified and analyzed.

In one or more embodiments, the processor 120 may be configured toidentify bone parts and/or cartilage parts of the joint in the radiologyimage by detecting high contrast areas such as edges or contours in theradiology image. The processor 120 may further be configured to identifystructures such as bone and/or cartilage in the radiology image bycomparing detected edges or contours, and/or comparing intensity levelsor patterns, with predefined templates.

As disclosed above, in one or more embodiments the processor 120 may beconfigured to, in the step of determining that there is damage byperforming a selection of image analysis and processing operations,detect that the intensity in an area within or adjacent to the boneand/or cartilage parts of the anatomical joint is higher or lower than apredetermined threshold. Depending on the settings of the imaging devicethat has captured the analyzed medical image data, the analyzed imagemay for example represent the following substances with differentintensity levels: cortical bone, fluid/liquids, cartilage, fat/bonemarrow and meniscus. It is for example an indication of damage if fluidis detected where there in a healthy joint should be no fluid. If fluidis detected next to abnormalities in the cartilage, this can also be anindication of damage.

Different intensity levels in the analyzed image correspond to differentsignal intensity levels, and these may typically be represented bypixel/voxel values ranging from 0 to 1, or in a visual representationshown as grey scale levels from white to black. In embodiments where thepixel/voxel values range from 0 to 1, a predetermined threshold is setto a suitable value between 0 and 1, or in other words to a suitablegrey scale value. In one or more embodiments the processor 120 mayfurther, or alternatively, be configured to, in the step of performing aselection of image analysis and processing operations, detect anirregular shape of at least one tissue part of the anatomical joint anddetermine whether this represents a damage to the anatomical joint. Inone or more embodiments the processor 120 may further, or alternatively,be configured to, in the step of performing a selection of imageanalysis and processing operations make a comparison of an identifiedtissue part in a damage image with a template representing a predefineddamage pattern for an anatomical joint. In some embodiments, such adetermination may include comparing a detected irregular shape of thecontour with a template representing a predefined damage pattern for ananatomical joint, and/or comparing a detected intensity for a certainarea with a template representing a predefined damage pattern for ananatomical joint.

In one or more embodiments, the processor 120 may be configured to mark,visualize or in another way indicate a determined damage to theanatomical joint in at least one of the one or more damage images of thedecision support material. To mark, visualize or indicate the determineddamage, the processor 120 may be configured to change the pixel/voxelvalue of one or more pixels/voxels on, in connection with, orsurrounding a pixel/voxel identified to belong to a determined damage,such that the determined damage is visually distinguished and noticeableto a user/viewer, by performing a selection of the following:

-   -   changing the luminance/intensity values of one or more        pixels/voxels identified as being located on a determined        damage;    -   changing one or more chrominance/color values of one or more        pixels/voxels identified as being located on a determined        damage;    -   changing the luminance/intensity values of one or more        pixels/voxels identified as surrounding a determined damage;    -   changing one or more chrominance/color values of one or more        pixels/voxels identified as surrounding a determined damage;        and/or    -   adding an annotation, symbol or other damage indicator to the        image, in connection with one or more pixels/voxels identified        as being located on, or surrounding, a determined damage.

In one or more embodiments, the processor 120 may be configured to markdamage to the anatomical joint in the obtained three-dimensional imagerepresentation of the anatomical joint or part of it. To mark damage,the processor 120 may be configured to change the voxel value of one ormore voxels on, in connection with, or surrounding a voxel identified tobelong to a determined damage, such that the determined damage isvisually distinguished and noticeable to a user/viewer, by performing aselection of the following:

-   -   changing the luminance/intensity values of one or more voxels        identified as being located on a determined damage;    -   changing one or more chrominance/color values of one or more        voxels identified as being located on a determined damage;    -   changing the luminance/intensity values of one or more voxels        identified as surrounding a determined damage;    -   changing one or more chrominance/color values of one or more        voxels identified as surrounding a determined damage; and/or    -   adding an annotation, symbol or other damage indicator to the        image, in connection with one or more voxels identified as being        located on, or surrounding, a determined damage.

In one or more embodiments, the processor may be configured tosynchronize, or associate, the series of radiology images and thethree-dimensional (3D) image representation, so that a marking made inone of the images appear in real time in the same position in the otherimage. The same position is hereinafter interpreted as the sameposition, or same location, on the anatomical joint that is depicted. Asthe 3D image representation is generated based on the radiology imagedata, the synchronization or association between the 2D radiology imagedata and the 3D representation can be automatically performed by theprocessor during the segmentation of radiology image data into a 3Drepresentation, in manners known in the art.

The series of radiology images may for example be captured during aprocess of scanning radiology images through different layers of theanatomical joint or part of it, which captures all the radiology imagedata necessary to generate a three-dimensional image representation ofthe anatomical joint or part of it in an image segmentation processbased on the radiology images. In some embodiments, damage may bedetermined for both bone parts and cartilage parts of the anatomicaljoint. Alternatively, damage to bone parts only, or damage to cartilageparts only, or damage to other tissue parts, may be determined,depending on the application.

In some embodiments, the anatomical joint is a knee. In otherembodiments, the anatomical joint may be any other anatomical jointsuitable for damage determination using image data analysis, such asankle, a hip, a toe, an elbow, a shoulder, a finger or a wrist.

In one or more embodiments, the processor may be configured to select asuitable treatment from a predefined set of treatments. The selectionmay be based on data from the radiology image and/or thethree-dimensional image representation of the anatomical joint or partof it.

In some embodiments, the processor may be configured to select asuitable implant from a predefined set of implants with varyingdimensions. In this context, a suitable implant means an implant havinga type and dimensions that match a determined damage, thereby making itsuitable for repairing the determined damage. In one or moreembodiments, the processor may be configured to visualize the selectedimplant in at least one of the one or more damage images.

In some embodiments, the processor may be configured to propose atransfer guide tool for osteochondral autograft transplantation,possibly also including suitable size and/or suitable harvesting and/orimplantation positions for at least one osteochondral autograft plug. Inthis context, a suitable harvesting position means a position where asuitable autograft plug can be harvested from the patient for repairingthe determined damage.

In some embodiments, the decision support material is adapted to be usedby medical staff, for example a surgeon or orthopedic staff member. Thedecision support material may then include a recommendation for asuitable treatment for repair of at least a part of the determineddamage.

Alternatively, the decision support material includes a recommendationfor a suitable design of one or more transfer guide tools for repair ofat least a part of the determined damage with osteochondral autografttransplantation. The decision support material may in this case alsoinclude a recommendation for a suitable harvesting site for such anosteochondral autograft plug. Such suitable harvesting sites and/ortransfer guide tools may further be visualized in the damage image ordamage report.

In some embodiments, the damage image is part of a decision supportmaterial adapted to be used by an insurance agent making an assessmentregarding a client or potential client; a patient who wants to beinformed about the condition of a damaged joint; or any other person whohas for example a commercial or academic interest in learning aboutdamage to a depicted anatomical joint.

The decision support material may be in the form of a printed report, orin the form of one or more computer files adapted to be viewed on e.g. atablet computer or a smart phone. If the decision support material is inthe form of one or more computer files, the one or more damage imagesmay be in the form of regular 2D images or in the form of an interactive3D model of the anatomical joint or part of it.

In one or more embodiments, the system 100 may optionally comprise adisplay 140 configured to display image data, for example in the form ofa damage image or a damage assessment report comprising one or moredamage images. The display 140 may be configured to receive image datafor display via the processor 120, and/or to retrieve image data fordisplay directly from the storage media 110, possibly in response to acontrol signal received from the processor 120 or an inputter 150, whichis further presented below.

In some embodiments, the system 100 may further optionally comprise oneor more inputters 150 configured to receive user input. The inputter 150is typically configured to interpret received user input and to generatecontrol signals in response to said received user input. The display 140and the inputter 150 may be integrated in, connected to orcommunicatively coupled to the system 100. The inputter 150 may forinstance be configured to interpret received user input that is beinginput in connection with a displayed damage image, or a displayed damageassessment report comprising one or more damage images, and generatecontrol signals in response to said received user input, to triggerdisplay of an image or manipulation of image data being displayed,wherein the manipulations may be temporary or permanent. Suchmanipulations may for example include providing annotations, moving orchanging an image or part of an image, changing the viewing perspective,zooming in or out, and/or any other suitable form of manipulation thatenables the user to view and analyze the displayed image data in animproved manner. An inputter 150 may for example comprise a selection ofa keyboard, a computer mouse, one or more buttons, touch functionality,a joystick, and/or any other suitable input device. In some embodiments,the processor 120 may be configured to receive a control signal from theinputter 150 and to process image data that is being displayed, or inother words manipulate a displayed image, in response to the receivedcontrol signal.

The processor 120 may further be configured to perform the method stepsof any or all of the embodiments presented herein.

Method Embodiments

FIG. 2 is a flow diagram of method embodiments for creating a decisionsupport material indicating damage to at least a part of an anatomicaljoint of a patient, wherein the decision support material comprises oneor more damage images. In accordance with one or more to embodiments,the method comprises:

In step 210: receiving a series of radiology images of the anatomicaljoint of a patient.

In some embodiments, the anatomical joint is a knee. In otherembodiments, the anatomical joint may be any other anatomical jointsuitable for damage determination using image data analysis, such asankle, a hip, a toe, an elbow, a shoulder, a finger or a wrist.

In step 220: obtaining a three-dimensional image representation of theanatomical joint which is based on said series of radiology images bygenerating said three-dimensional image representation in an imagesegmentation process based on said radiology images, or receiving saidthree-dimensional image representation from a storage media.

In step 230: identifying tissue parts of the anatomical joint, includingat least cartilage, tendons and/or ligaments, in at least one of theseries of radiology images using image analysis.

In one or more embodiments, the image analysis identifies bone partsand/or cartilage parts of the joint in the radiology image by the stepsof detecting high contrast areas such as edges or contours in theradiology image, and further identifying structures, such as bone and/orcartilage, in the radiology image through comparing the detected edgesor contours with predefined templates.

In some embodiments, damage may be determined for both bone parts andcartilage parts of the anatomical joint.

It may in some embodiments be advantageous to identify and analyze boneand cartilage of the depicted joint in the input radiology image/medicalimage data, as the combination of the two may provide additionalinformation, but all embodiments described herein can also be performedwhen only one of the substances bone and cartilage, or any other tissuepart, of the depicted joint is being identified and analyzed.

In step 240: determining damage to the anatomical joint by analyzing theradiology image and/or the three-dimensional image representation of theanatomical joint or part of it.

In different embodiments, the analysis in step 230 may compriseperforming a selection of any or all of the following image analysis andimage processing operations:

-   -   detecting an irregular shape of a contour of at least one tissue        part of the anatomical joint; and/or    -   detecting that the intensity in an area within or adjacent to        bone and/or cartilage parts of the anatomical joint is higher or        lower than a predetermined value; and/or    -   comparing at least one identified tissue part with a template        representing a predefined damage pattern for an anatomical        joint.

In one or more embodiments, method step 240 may comprise detecting thatthe intensity in an area within or adjacent to the bone and/or cartilageparts of the anatomical joint is higher or lower than a predeterminedthreshold. Depending on the settings of the imaging device that hascaptured the analyzed medical image data, the analyzed image may forexample represent the following substances with different intensitylevels: cortical bone, liquids, cartilage, fat/bone marrow and meniscus.Different intensity levels in the analyzed image correspond to differentsignal intensity levels and these may typically be represented bypixel/voxel values ranging from 0 to 1, or in a visual representationshown as grey scale levels from white to black. In embodiments where thepixel/voxel values range from 0 to 1, a predetermined threshold is setto a suitable value between 0 and 1, or in other words to a suitablegrey scale value.

In one or more embodiments, method step 240 may further, oralternatively, comprise detecting an irregular shape of a contour of theat least one tissue part of the anatomical joint and determine whetherthis represents a damage to the anatomical joint.

In one or more embodiments, method step 240 may further, oralternatively, comprise making a comparison of an identified tissue partin a damage image with a template representing a predefined damagepattern for an anatomical joint. In some embodiments, such adetermination may include comparing a detected irregular shape of thecontour with a template representing a predefined damage pattern for ananatomical joint, and/or comparing a detected intensity for a certainarea with a template representing a predefined damage pattern for ananatomical joint.

In step 250: marking damage to the anatomical joint in the obtainedthree-dimensional image representation of the anatomical joint or partof it.

In step 260: generating a decision support material, where damage to theanatomical joint is marked in at least one of the one or more damageimages of the decision support material, and at least one of the damageimages is generated based on the obtained three-dimensional imagerepresentation of the anatomical joint or part of it.

It may in some embodiments be advantageous to identify, in step 230, andanalyze, in step 240, both bone and cartilage of the depicted joint inthe input radiology image/medical image data, as the combination of thetwo may provide additional information, but all embodiments describedherein may also be performed when only one of the two substances bone orcartilage or any other tissue part of the depicted joint is identifiedand analyzed.

In one or more embodiments, the marking of method steps 250 and 260comprises marking, visualizing or in another way indicating thedetermined damage to the anatomical joint. Marking, visualizing, orindicating the determined damage may include changing the pixel/voxelvalue of one or more pixels/voxels on, in connection with, orsurrounding a pixel/voxel identified to belong to a determined damage,such that the determined damage is visually distinguished and noticeableto a user/viewer. Such a change of pixel/voxel values of one or morepixels/voxels on, in connection with, or surrounding a pixel/voxelidentified to belong to a determined damage may for example comprise aselection of the following:

-   -   changing the luminance/intensity values of one or more        pixels/voxels identified as being located on a determined        damage;    -   changing one or more chrominance/color values of one or more        pixels/voxels identified as being located on a determined        damage;    -   changing the luminance/intensity values of one or more        pixels/voxels identified as surrounding a determined damage;    -   changing one or more chrominance/color values of one or more        pixels/voxels identified as surrounding a determined damage;        and/or    -   adding an annotation, symbol or other damage indicator to the        image, in connection with one or more pixels/voxels identified        as being located on, or surrounding, a determined damage.

In some embodiments, the radiology image and the three-dimensional imagerepresentation may be associated, or synchronized, so that a markingmade in one of the images appear in the same position in the otherimage. According to one or more such embodiment, method steps 250 and260 may comprise associating, or synchronizing, the radiology image andthe three-dimensional image representation, so that a marking made inone of the images appear in the same position in the other image.

FIG. 3 shows an example of a decision support material in the form ofdamage images wherein damage to an anatomical joint is marked usinggraphics, in accordance with one or more embodiments described herein.In the non-limiting example shown in FIG. 3, a decision support material300 in the form of damage images shows two visual representations 310,330 of an anatomical joint, wherein a determined damage 320, 340 ismarked/indicated/visualized by changing the luminance/intensity levelsand/or chrominance/color values of a number of pixels/voxels identifiedas being located on and surrounding a determined damage. Of course, anyluminance/intensity values and/or chrominance/color values may bechosen, depending on the application, and depending on what provides aclear marking, visualization, or indication that enables a personviewing the decision support material to see and analyze the determineddamage. A chosen luminance/intensity value and/or chrominance/colorvalue may in embodiments be assigned to a pixel/voxel by replacing theprevious pixel/voxel value, or by blending the new pixel/voxel valueswith the old pixel/voxel value using a scaling factor, such as an alphablending factor. A single determined damage may further be marked,visualized, or indicated using different assigned pixel/voxel valuesdepending on the type of damage that each pixel represents. As anexample, marking, visualizing, or indicating a damage may comprisedifferent new pixel/voxel values for:

-   -   a full-depth damage, i.e. a cartilage damage down to the bone;    -   a partial depth damage, such as degenerated cartilage,        regenerated cartilage/scar tissue, or deformed cartilage;    -   a bone marrow lesion (BML); and    -   a distinct cyst.

Examples of decision support material in the form of one or more damageimages, or a damage report comprising one or more damage images, arediscussed further in connection with FIGS. 5 and 6.

FIG. 4 is a flow diagram of one or more method embodiments for creatinga damage image of an anatomical joint where damage to the joint ismarked in the damage image, and further the optional method steps ofincluding in the image a recommendation of a suitable implant forrepairing a determined damage. Steps 210-260 of FIG. 4 correspond to thesame steps of FIG. 2, and the method embodiments of FIG. 4 furthercomprises the following additional steps:

In step 470: selecting a suitable implant from a predefined set ofimplants with varying dimensions, based on data from the radiology imageand/or the three-dimensional image representation of the anatomicaljoint or part of it.

In this context, a suitable implant means an implant having a type anddimensions that match a determined damage, thereby making it suitablefor repairing the determined damage.

In step 480: visualizing the selected implant in at least one of the oneor more damage images.

In some embodiments, the decision support material may further include arecommendation and/or a position indication of a suitable implant forthe determined bone and/or cartilage damage. Such a suitable implant mayfurther be visualized in the damage image or damage report.

An example of how a selected implant may be visualized in a damage imageor damage report is shown in FIG. 5, which shows an example of adecision support material 500 in the form of a damage report comprisinga number of damage images 510, 530, 560, 570 wherein damage 520, 540 toan anatomical joint is marked and/or a type and placement of a suitableimplant 550, 580 is indicated, in accordance with one or moreembodiments described herein.

An example of the damage image may be used to visualize osteochondralautograft implantation is shown in FIG. 8, which shows an example of adamage image 810 in which the placement of a proposed transfer guidetool for osteochondral autograft transplantation is indicated in 820, inaccordance with one or more embodiments described herein.

In one or more embodiments, the decision support material is adapted tobe used by medical staff, for example a surgeon or orthopedic staffmember. In one or more embodiments, the decision support material isadapted to be used by medical staff, for example a surgeon or orthopedicstaff member, and further includes a recommendation for a suitableimplant, according to any of the embodiments described in connectionwith FIG. 3.

In some embodiments, the decision support material is adapted to be usedby an insurance agent making an assessment regarding a client orpotential client; a patient who wants to be informed about the conditionof a damaged joint; or any other person who has for example a commercialor academic interest in learning about damage to a depicted anatomicaljoint.

In some embodiments, the decision support material comprises a 2D and a3D image representing a 3D visualization or 3D model of at least a partof an anatomical joint of a patient, visual marking/indication of adamage to the joint, and an annotation/a written assessment ofanatomical deviations. FIG. 6 shows an example of a part of a decisionsupport material comprising two damage images 600, 610, wherein damageto an anatomical joint that is depicted in the damage images 600, 610 ismarked/indicated/visualized using an annotation 620, in accordance withone or more embodiments described herein. In the non-limiting example ofFIG. 6, the depicted anatomical joint is a knee, and the annotation 620indicates that the patient has a lesion in the patella.

In one or more embodiments, the methods of FIG. 2 or 4 may optionallycomprise displaying a visual representation of a decision supportmaterial in the form of one or more damage images, or a damageassessment report comprising one or more damage images, for example in agraphical user interface (GUI). As shown in the non-limiting examples ofFIGS. 3, 5 and 6, a visual representation presented in a GUI maycomprise one or more damage images where damage to an anatomical jointis marked/visualized/indicted, for instance like the damage image 300 ofFIG. 3, or a damage report comprising damage images along with a 2Drepresentation and a 3D representation of the joint indicating a correctposition of a recommended implant or guide tool, like the damage report500 of FIG. 5, and/or medical image data wherein adding of annotationsis enabled, like the annotation 620 added to indicate important medicalinformation to the medical images 600 and 610 in FIG. 6. The method mayin any of these embodiments comprise receiving image data for display,and/or receiving a control signal and retrieving image data for displayin response to the control signal.

In one or more embodiments, a damage image or another part of a damageassessment report or decision support material that is being displayedmay be manipulated by a user using one or more inputters integrated in,connected to, or communicatively coupled to the display or a systemcomprising the display. According to these embodiments, the method ofFIG. 2 or 4 may further optionally comprise receiving user input from aninputter, interpret the received user input, and generate one or morecontrol signals in response to the received user input. The receiveduser input may relate to a displayed damage image, or a displayed damageassessment report comprising one or more damage images, and generatecontrol signals in response to said received user input to manipulatewhat is being displayed, temporarily or permanently. The manipulationmay for example include providing annotations, moving or changing animage or part of an image, changing the viewing perspective, zooming inor out, and/or any other suitable form of manipulation that enables theuser to view and analyze the displayed image data in an improved manner.In some embodiments, the method of FIG. 2 or 4 may comprise receiving acontrol signal from an inputter and processing the image data that isbeing displayed, or in other words manipulate the displayed image, inresponse to the control signal.

The foregoing disclosure is not intended to limit the present inventionto the precise forms or particular fields of use disclosed. It iscontemplated that various alternate embodiments and/or modifications tothe present invention, whether explicitly described or implied herein,are possible in light of the disclosure. Accordingly, the scope of theinvention is defined only by the claims.

Use Case Embodiment

To set the presently disclosed methods and systems in a larger context,the damage marking and the generation of one or more damage images,and/or damage report, according to any of the disclosed embodiments, mayin use case embodiments be preceded by capturing and/or obtainingmedical image data representing an anatomical joint or part of it, andmay further be followed by actions to be taken in view of repairing anydetermined damage.

FIG. 7 is a flow diagram exemplifying one such larger context, includingobtaining medical image data from an image source, determining damage toa depicted anatomical joint and generating a damage image or damagereport in accordance with one or more embodiments described herein. FIG.7 further includes steps of designing and producing an implant and/orguide tool suitable for repairing a determined damage in an anatomicaljoint. In FIG. 7, everything except the determination of damage, damagemarking and decision support material generation of step 740, using theinput medical image data 730 and resulting in the output decisionsupport material 740, is marked with dashed lines to clarify they areoptional steps shown in the figure to provide context only, and notessential to any of the embodiments presented herein. Especially, steps770 and 780 relating to diagnosis/decision on treatment and design andproduction of implant/guide tool are not part of the embodimentspresented herein.

According to the example shown in FIG. 7, medical image data 730 may beobtained in a step 700 in the form of radiology image data from aradiology imaging system. The radiology image data obtained may forexample be generated using one or more of a variety of imagingtechniques such as X-ray images, ultrasound images, computed tomography(CT) images, nuclear medicine including positron emission tomography(PET) images, and magnetic resonance imaging (MRI) images. The radiologyimage data may for example be captured during a process of scanningradiology images through different layers of the anatomical joint orpart of it, which captures all the radiology image data necessary togenerate a three-dimensional image representation of the anatomicaljoint or part of it in an image segmentation process based on theradiology image data.

The image data obtained in step 400 may further be processed in a step710, by performing segmentation and 3D modulation to obtain a 3Drepresentation of what is depicted in the captured image data. Forinstance, if the image data captured depict an anatomical joint, the 3Drepresentation would be a 3D representation of the anatomical joint.Medical image data may also be obtained in a step 720 from a differentkind of image source that provides 2D image data. The 3D image data andthe 2D image data both depict the same object, namely the anatomicaljoint of interest for damage determination. The medical image data 730may therefore, as described herein, comprise 3D image data and/or 2Dimage data representing an anatomical joint, obtained using differentimaging systems. The image data may represent only a part of theanatomical joint.

In embodiments where the medical image data 730 comprises both 3D and 2Dimage data, the 3D and 2D image data may be combined into a singlevisual representation, or be separate visual representations. Theseparate visual representations may in embodiments be associated, orsynchronized, such that a position on an object depicted in the 3Dvisual representation is associated with the same position on the sameobject in the 2D visual representation. Thereby, if a marking of adetermined damage is done in the 3D visual representation, it willappear on the same position on the depicted anatomical joint in the 2Drepresentation, and vice versa. Of course, once the 3D and 2D visualrepresentations have been associated, or synchronized, the same wouldapply to for example annotations placed in connection with a position ofthe depicted joint, or any modification done to the 3D or 2D visualrepresentation.

In a step 740, damage determination, marking of damage in the inputmedical image data 730 and generation of the output decision supportmaterial 750 is performed, in accordance with any of the embodimentspresented herein in connection with the method and system descriptions.The decision support material 750 may, in accordance with embodimentsdescribed herein, be in the form of one or more damage images whereindetermined image to the depicted anatomical joint is marked, or in theform of a report comprising one or more such images. The decisionsupport material 750 may optionally, in accordance with embodimentsdescribed herein, comprise an indication of one or more suitableimplants and/or guide tools that may be used for repairing a determineddamage. In this context, a suitable implant and/or guide tool means animplant and/or guide tool having a type and dimensions that match thedetermined damage, thereby making it suitable for repairing thedetermined damage. The one or more suitable implants and/or guide toolsmay be selected in the optional step 760, and may be presentedgraphically in connection with the 3D and/or 2D visual representation(s)of the marked medical image data of the decision support material 750,for example in the position where the implant and/or guide tool shouldoptimally be inserted to repair the determined damage. Alternatively,the one or more suitable implants and/or guide tools may be selected inthe optional step 470 and may be presented separated from the 3D and/or2D visual representations for example as a graphical representationand/or a text annotation.

In a use case embodiment, a medical staff member, for example a surgeonor orthopedic staff member, may use a generated decision supportmaterial 750 to make a correct diagnosis and make a decision 770 on andecision of optimal treatment of the patient whose anatomical joint hasbeen depicted. If the medical staff member decides that an implant isrequired, this may lead up to the step 780 of designing and producing asuitable implant and/or guide tool, possible according to an indicationthat may be provided in the decision support material, as describedherein, for repairing the determined damage.

In another use case embodiment, a person using the decision supportmaterial 750 may be a person other than a medical staff member that hasan interest in learning about any damage to the depicted anatomicaljoint, for example an insurance agent assessing a client or a potentialclient, a patient who wants to be informed about the condition of adamaged joint, or any other person who has for example a commercial oracademic an interest in learning about any damage to a depictedanatomical joint.

Further Embodiments

Where applicable, various embodiments provided by the present disclosurecan be implemented using hardware, software, or combinations of hardwareand software. Also where applicable, the various hardware componentsand/or software components set forth herein can be combined intocomposite components comprising software, hardware, and/or both withoutdeparting from the claimed scope of the present disclosure. Whereapplicable, the various hardware components and/or software componentsset forth herein can be separated into sub-components comprisingsoftware, hardware, or both without departing from the claimed scope ofthe present disclosure. In addition, where applicable, it iscontemplated that software components can be implemented as hardwarecomponents, and vice-versa. The method steps of one or more embodimentsdescribed herein may be performed automatically, by any suitableprocessing unit, or one or more steps may be performed manually. Whereapplicable, the ordering of various steps described herein can bechanged, combined into composite steps, and/or separated into sub-stepsto provide features described herein.

Software in accordance with the present disclosure, such as program codeand/or data, can be stored in non-transitory form on one or moremachine-readable mediums. It is also contemplated that softwareidentified herein can be implemented using one or more general purposeor specific purpose computers and/or computer systems, networked and/orotherwise.

In embodiments, there are provided a computer program product comprisingcomputer readable code configured to, when executed in a processor,perform any or all of the method steps described herein. In someembodiments, there are provided a non-transitory computer readablememory on which is stored computer readable and computer executable codeconfigured to, when executed in a processor, perform any or all of themethod steps described herein.

In one or more embodiments, there is provided a non-transitorymachine-readable medium on which is stored machine-readable code which,when executed by a processor, controls the processor to perform themethod of any or all of the method embodiments presented herein.

The invention claimed is:
 1. A system for creating a decision supportmaterial indicating damage to at least a part of an anatomical joint ofa patient, wherein the created decision support material comprises oneor more damage images, the system comprising a storage media and atleast one processor, wherein the at least one processor is configuredto: i) receive a series of radiology images of the at least part of theanatomical joint from the storage media; ii) obtain a three-dimensionalimage representation of the at least part of the anatomical joint whichis based on said series of radiology images, by generating saidthree-dimensional image representation in an image segmentation processbased on said series of radiology images, or receiving saidthree-dimensional image representation from a storage media; iii)identify tissue parts of the anatomical joint, including at leastcartilage, tendons and/or ligaments, in at least one of the series ofradiology images and/or the three-dimensional image representation usingimage analysis; iv) determine damage to the identified tissue parts inthe anatomical joint by analyzing said at least one of the series ofradiology images and/or the three-dimensional image representation ofthe at least part of the anatomical joint, wherein the analysis uses theidentified tissue parts and comprises a selection of: detecting anirregular shape of a contour of at least one tissue part of theanatomical joint; and/or detecting that the intensity in an area withinor adjacent to bone and/or cartilage parts of the anatomical joint ishigher or lower than a predetermined value; and/or comparing at leastone identified tissue part with a template representing a predefineddamage pattern for an anatomical joint; v) mark damage to the anatomicaljoint in the obtained three-dimensional image representation of theanatomical joint; and vi) generate a decision support material, wherethe determined damage to the at least part of the anatomical joint ismarked in at least one of the one or more damage images of the decisionsupport material, and at least one of the one or more damage images isgenerated based on the obtained three-dimensional image representationof the at least part of the anatomical joint.
 2. The system according toclaim 1, wherein at least one of the one or more damage images is aninteractive 3D model of the anatomical joint or part of it.
 3. Thesystem according to claim 1, wherein the processor is configured toidentify bone parts and/or cartilage parts of the joint in said at leastone radiology image by: detecting high contrast areas such as edges orcontours in the radiology image; and identifying structures, such asbone and/or cartilage, in the radiology image through comparing thedetected areas with predefined templates.
 4. The system according toclaim 1, wherein the processor is further configured to associate theradiology images and the three-dimensional image representation, so thata marking made in one of the images appears in the same position inanother image.
 5. The system according to claim 1, wherein thethree-dimensional image representation is generated in an imagesegmentation process which depends on a segmentation process controlparameter set.
 6. The system according to claim 1, wherein the imageanalysis identifies both bone parts and cartilage parts of theanatomical joint or part of it and damage is determined to both the boneparts and the cartilage parts.
 7. The system according to claim 1,wherein the processor is further configured to select a suitabletreatment from a predefined set of treatments based on data from theradiology images and/or the three-dimensional image representation ofthe at least part of the anatomical joint.
 8. The system according toclaim 7, wherein the processor is configured to: select a suitableimplant from a predefined set of implants with varying dimensions,and/or propose a transfer guide tool for osteochondral autografttransplantation, possibly including suitable size and/or suitableharvesting and/or implantation positions for at least one osteochondralautograft plug; and to visualize the selected implant and/or thetransfer guide tool and/or the suitable harvesting and/or implantationpositions for at least one osteochondral autograft plug in at least oneof the one or more damage images.
 9. The system according to claim 1,wherein the decision support material is adapted to be used by medicalstaff, and includes a recommendation for a suitable treatment for repairof the determined damage.
 10. A method for creating a decision supportmaterial indicating damage to at least a part of an anatomical joint ofa patient, wherein the created decision support material comprises oneor more damage images, the method comprising the steps of: i) receivinga series of radiology images of the at least part of the anatomicaljoint; ii) obtaining a three-dimensional image representation of the atleast part of the anatomical joint which is based on said series ofradiology images, by generating said three-dimensional imagerepresentation in an image segmentation process based on said radiologyimages, or receiving said three-dimensional image representation from astorage media; iii) identifying tissue parts of the anatomical joint,including at least cartilage, tendons and/or ligaments, in at least oneof the series of radiology images using image analysis; iv) determiningdamage to the identified tissue parts in the anatomical joint byanalyzing said at least one of the series of radiology images and/or thethree-dimensional image representation of the at least part of theanatomical joint using the identified tissue parts and a selection of:detecting an irregular shape of a contour of the at least one tissuepart of the anatomical joint; and/or detecting that the intensity in anarea within or adjacent to bone and/or cartilage parts of the anatomicaljoint is higher or lower than a predetermined value; and/or comparing atleast one identified tissue part with a template representing apredefined damage pattern for an anatomical joint; v) marking damage tothe anatomical joint in the obtained three-dimensional imagerepresentation of the at least part of the anatomical joint; and vi)generating a decision support material, where the determined damage tothe anatomical joint is marked in at least one of the one or more damageimages of the decision support material, and at least one of the one ormore damage images is generated based on the obtained three-dimensionalimage representation of the at least part of the anatomical joint. 11.The method according to claim 10, wherein at least one of the one ormore damage images is an interactive 3D model of the anatomical joint orpart of it.
 12. The method according to claim 10, wherein the imageanalysis identifies bone parts and/or cartilage parts of the joint insaid at least one radiology image by the steps of: detecting highcontrast areas such as edges or contours in the radiology image; andidentifying structures, such as bone and/or cartilage, in the radiologyimage through comparing the detected edges or contours with predefinedtemplates.
 13. The method according to claim 10, wherein the radiologyimages and the three-dimensional image representation are associated, sothat a marking made in one of the images appears in the same position inanother of the images.
 14. The method according to claim 10, wherein thethree-dimensional image representation is generated in an imagesegmentation process which depends on a segmentation process controlparameter set.
 15. The method according to claim 10, wherein the imageanalysis identifies both bone parts and cartilage parts of theanatomical joint or part of it and damage is determined to both the boneparts and the cartilage parts.
 16. The method according to claim 10,further comprising selecting a suitable treatment from a predefined setof treatments based on data from the radiology images and/or thethree-dimensional image representation of the at least part of theanatomical joint.
 17. The method according to claim 16, furthercomprising: selecting a suitable implant from a predefined set ofimplants with varying dimensions, and/or proposing a transfer guide toolfor osteochondral autograft transplantation, possibly including suitablesize and/or suitable harvesting and/or implantation positions for atleast one osteochondral autograft plug; and visualizing the selectedimplant and/or the transfer guide tool and/or the suitable harvestingand/or implantation positions for at least one osteochondral autograftplug in at least one of the one or more damage images.
 18. The methodaccording to claim 10, wherein the decision support material is adaptedto be used by medical staff, and includes a recommendation for asuitable treatment for repair of the determined damage.
 19. A decisionsupport material indicating damage to at least a part of an anatomicaljoint of a patient, wherein the decision support material comprises oneor more damage images generated by the method steps of claim 10, whereinthe decision support material is stored in a non-transitorycomputer-readable storage medium and wherein at least one of the one ormore damage images is an interactive 3D model of the anatomical joint orpart of the anatomical joint.
 20. The decision support material of claim19, further comprising the three-dimensional image representation on thebasis of which the one or more damage images have been generated.
 21. Anon-transitory machine-readable medium on which is storedmachine-readable code which, when executed by a processor, controls theprocessor to perform the method steps of claim 10.